Few doctors specializing in treating older patients

PALATKA, Fla. —In this sleepy, riverside town in northeast Florida, 86-year-old Betty Wills sees the advertisements of obstetricians and gynecologists on the main road's billboards and has found specialists ranging from cardiologists to surgeons in the phone book.

But there's not a single geriatrician — a doctor who specializes in treating the elderly — in all of Putnam County, where a fifth of the county's 74,000 people are seniors.

"I looked," Wills said. "I didn't find one."

It's a nationwide shortage and it's going to get worse as the 70 million members of the baby-boom generation — those now 46 to 65 — reach their senior years over the next few decades.

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The American Geriatrics Society says today there's roughly one geriatrician for every 2,600 people 75 and older. Without a drastic change in the number of doctors choosing the specialty, the ratio is projected to fall to one geriatrician for every 3,800 older Americans by 2030. Compare that to pediatricians: there is about 1 for every 1,300 Americans under 18.

Geriatricians, at their best, are medicine's unsung heroes. They understand how an older person's body and mind work differently. They listen more but are paid less than their peers. They have the skills to alleviate their patients' ailments and help them live fuller, more satisfied lives.

Though not every senior needs a geriatrician, their training often makes them the best equipped to respond when an older patient has multiple medical problems. Geriatricians have expertise in areas that general internists don't, including the changes in cognitive ability, mood, gait, balance and continence, as well as the effects of drugs on older individuals.

But with few doctors drawn to the field and some fleeing it, the disparity between the number of geriatricians and the population it serves is destined to grow even starker.

"We're an endangered species," said Rosanne Leipzig, a renowned geriatrician at Mount Sinai Medical Center in New York.

Geriatricians rank among the lowest-paid medical specialties, with a median salary of $183,523 last year, according to the Medical Group Management Association, which tracks physician pay. That sounds like a lot, but many other specialties pay two or three times more, while the average doctor graduates with $160,000 in student loan debt.

Just 56 percent of first-year fellowship slots in geriatrics were filled last academic year, according to a University of Cincinnati study, while the number physicians on staff at U.S. medical schools' geriatric programs has generally been trending downward.

Many young doctors aren't receiving even basic training in caring for older patients. Only 56 percent of medical students had clinical rotations in geriatrics in 2008, according to the study.